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Diagnosis and management of interstitial lung disease.

Meyer KC - Transl Respir Med (2014)

Bottom Line: When patients are evaluated for suspected ILD, an accurate diagnosis of the specific form of ILD that a patient has developed must be made to provide the patient with useful prognostic information and to formulate an appropriate management plan that can relieve symptoms and restore or significantly improve quality of life.If treatment is indicated, many forms of ILD can respond significantly to immunosuppressive anti-inflammatory therapies.Finally, lung transplantation is an option for patients with progressive, advanced disease that does not respond to other therapies, but only a relatively small subset of patients with end-stage ILD are able to meet wait listing requirements and eventually undergo successful lung transplantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin USA.

ABSTRACT
The complex tasks of making a confident diagnosis of a specific form of interstitial lung disease (ILD) and formulating a patient-centered, personalized management plan in an attempt to achieve remission or stabilization of the disease process can pose formidable challenges to clinicians. When patients are evaluated for suspected ILD, an accurate diagnosis of the specific form of ILD that a patient has developed must be made to provide the patient with useful prognostic information and to formulate an appropriate management plan that can relieve symptoms and restore or significantly improve quality of life. A well-performed patient history and physical examination provides invaluable information that can be combined with appropriate laboratory testing, imaging, and, if needed, tissue biopsy to reach a confident ILD diagnosis, and high-resolution computed tomography (HRCT) of the thorax is usually a key component of the diagnostic evaluation. If treatment is indicated, many forms of ILD can respond significantly to immunosuppressive anti-inflammatory therapies. However, ILD accompanied by extensive fibrosis may be difficult to treat, and the identification of an effective pharmacologic therapy for idiopathic pulmonary fibrosis (IPF) has remained elusive despite the completion of many phase 3 clinical trials over the past decade. Nonetheless, patients with IPF or advanced forms of non-IPF ILD can benefit significantly from detection and treatment of various co-morbid conditions that are often found in patients (especially the elderly patient), and supportive care (oxygen therapy, pulmonary rehabilitation) can have a beneficial impact on quality of life and symptom palliation. Finally, lung transplantation is an option for patients with progressive, advanced disease that does not respond to other therapies, but only a relatively small subset of patients with end-stage ILD are able to meet wait listing requirements and eventually undergo successful lung transplantation.

No MeSH data available.


Related in: MedlinePlus

HRCT cross-sectional view showing a pattern of peripheral reticulation and honeycomb change that is diagnostic of the presence of UIP.
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Fig1: HRCT cross-sectional view showing a pattern of peripheral reticulation and honeycomb change that is diagnostic of the presence of UIP.

Mentions: Although the combination of history, physical examination, CXR, and other appropriate laboratory testing (peripheral blood tests and lung physiologic testing) may provide a likely diagnosis, additional testing is usually needed to reach a confident diagnosis of a specific ILD. HRCT of the thorax can provide invaluable information that strongly supports a specific diagnosis (Table 5) and may be diagnostic (e.g. typical changes of UIP) such that further testing with bronchoscopy or surgical lung biopsy is not required (Figure 1). Indeed, the HRCT has become a standard test for the evaluation of patients with possible ILD [4]. In general, a complete lack of pulmonary parenchymal changes on HRCT imaging virtually excludes a diagnosis of ILD, although ILD may rarely still be present with the lungs having microscopic involvement that does not reach the threshold for the detection of an abnormality that is detectable by HRCT. Multi-detector computed tomography (MDCT) scanning can scan the entire thorax with a single breath-hold maneuver and allow even better imaging than traditional HRCT, and an algorithmic approach can be utilized that facilitates differentiation among UIP, NSIP, and chronic HP patterns [5].Figure 1


Diagnosis and management of interstitial lung disease.

Meyer KC - Transl Respir Med (2014)

HRCT cross-sectional view showing a pattern of peripheral reticulation and honeycomb change that is diagnostic of the presence of UIP.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215823&req=5

Fig1: HRCT cross-sectional view showing a pattern of peripheral reticulation and honeycomb change that is diagnostic of the presence of UIP.
Mentions: Although the combination of history, physical examination, CXR, and other appropriate laboratory testing (peripheral blood tests and lung physiologic testing) may provide a likely diagnosis, additional testing is usually needed to reach a confident diagnosis of a specific ILD. HRCT of the thorax can provide invaluable information that strongly supports a specific diagnosis (Table 5) and may be diagnostic (e.g. typical changes of UIP) such that further testing with bronchoscopy or surgical lung biopsy is not required (Figure 1). Indeed, the HRCT has become a standard test for the evaluation of patients with possible ILD [4]. In general, a complete lack of pulmonary parenchymal changes on HRCT imaging virtually excludes a diagnosis of ILD, although ILD may rarely still be present with the lungs having microscopic involvement that does not reach the threshold for the detection of an abnormality that is detectable by HRCT. Multi-detector computed tomography (MDCT) scanning can scan the entire thorax with a single breath-hold maneuver and allow even better imaging than traditional HRCT, and an algorithmic approach can be utilized that facilitates differentiation among UIP, NSIP, and chronic HP patterns [5].Figure 1

Bottom Line: When patients are evaluated for suspected ILD, an accurate diagnosis of the specific form of ILD that a patient has developed must be made to provide the patient with useful prognostic information and to formulate an appropriate management plan that can relieve symptoms and restore or significantly improve quality of life.If treatment is indicated, many forms of ILD can respond significantly to immunosuppressive anti-inflammatory therapies.Finally, lung transplantation is an option for patients with progressive, advanced disease that does not respond to other therapies, but only a relatively small subset of patients with end-stage ILD are able to meet wait listing requirements and eventually undergo successful lung transplantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin USA.

ABSTRACT
The complex tasks of making a confident diagnosis of a specific form of interstitial lung disease (ILD) and formulating a patient-centered, personalized management plan in an attempt to achieve remission or stabilization of the disease process can pose formidable challenges to clinicians. When patients are evaluated for suspected ILD, an accurate diagnosis of the specific form of ILD that a patient has developed must be made to provide the patient with useful prognostic information and to formulate an appropriate management plan that can relieve symptoms and restore or significantly improve quality of life. A well-performed patient history and physical examination provides invaluable information that can be combined with appropriate laboratory testing, imaging, and, if needed, tissue biopsy to reach a confident ILD diagnosis, and high-resolution computed tomography (HRCT) of the thorax is usually a key component of the diagnostic evaluation. If treatment is indicated, many forms of ILD can respond significantly to immunosuppressive anti-inflammatory therapies. However, ILD accompanied by extensive fibrosis may be difficult to treat, and the identification of an effective pharmacologic therapy for idiopathic pulmonary fibrosis (IPF) has remained elusive despite the completion of many phase 3 clinical trials over the past decade. Nonetheless, patients with IPF or advanced forms of non-IPF ILD can benefit significantly from detection and treatment of various co-morbid conditions that are often found in patients (especially the elderly patient), and supportive care (oxygen therapy, pulmonary rehabilitation) can have a beneficial impact on quality of life and symptom palliation. Finally, lung transplantation is an option for patients with progressive, advanced disease that does not respond to other therapies, but only a relatively small subset of patients with end-stage ILD are able to meet wait listing requirements and eventually undergo successful lung transplantation.

No MeSH data available.


Related in: MedlinePlus